Wasting and lipodystrophy in patients infected with HIV: a practical approach in clinical practice

The care of patients who have HIV infection must address multiple medical, psychological, and socioeconomic factors. Because of the time constraints of a typical 15-minute office visit, important issues may be overlooked unless the physician has a clear concept of priorities and a clear method of tracking information. Although the medical aspects--viral control--must take priority, the psychological and social consequences of the illness must not be ignored. Nutritional evaluation and counseling must be addressed because nutritional disturbances often adversely affect the general health of patients who are infected with HIV. Important nutritional complications of HIV infection are the syndromes of wasting and lipodystrophy. However, the onset of wasting may not be heralded by a change in the patient's weight. In patients who have AIDS, the mechanism leading to a loss of skeletal muscle mass has not been identified. HIV-related lipodystrophy consists of accumulation of fat in the subcutaneous tissues of the lower trunk, abdominal viscera, and dorsocervical region with loss of fat from the upper and lower extremities, buttocks, and face. Lipodystrophy in association with HIV infection is not the same as the wasting syndrome of protein-energy malnutrition. An early sign of lipodystrophy is facial wasting. The treatment of the nutritional complications of HIV infection includes exercise; nutritional counseling; and in selected patients, androgenic hormones, anabolic steroid hormones, and human growth hormone.